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HOMES reports dual-eligible care organization rescinds July Medicare cuts

HOMES Alert: HOMES is happy to send our members great news as we enter into the Labor Day weekend. Wayne Dolloff (Collins Surgical) has informed HOMES that Senior Whole Health (SWH) is rescinding the Medicare July 1st reimbursement rates and rolling them back to the Medicare January 1st rates.  Although they are working on reloading the new rates, no timeline was given for completion. According to Wayne, they are also working on how to reconcile claims that were paid after July 1st. Providers should contact SWH for more information.

SWH was initially not budging on the rate reduction because they weren’t getting many calls – until HOMES notified our members in an alert last week.  SWH told Wayne that “the storm hit last week.  We are getting tons of calls.”

“This is the perfect example of the value of membership and the power of member engagement,” said Karyn Estrella, HOMES President & CEO. “Insurance plans are dropping reimbursement rates but not informing their provider networks. When our members make us aware of rate cuts, we pass that information on to our members so they can take appropriate action. It appears that the volume of calls from providers caused them to reconsider.”

As previously reported, TRICARE has adopted the July 1st Medicare fee schedule. Michael McDonald (Clinical 1 Home Medical), who first alerted HOMES to the SWH reimbursement cut, has informed us that Commonwealth Care Alliance (CCA) has also cut their rates and Fallon Community Health Plan’s (FCHP) reimbursement is below the 7/1 Medicare fee schedule.

Watch your EOB’s – know what your insurance companies are paying.  Keep HOMES informed so we can alert our members so they can take action.  Estrella added, “As we saw with MaineCare rescinding their reimbursement cut several weeks ago, when many providers react and communicate with the payor, change is possible.”